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  1. 1. Dr. Naeem Hassan Saleem MPH,MSc. [email_address] Next Wave of HIV epidemic in Punjab, Pakistan
  2. 2. Background & Methods <ul><li>AIDS Control Program has established second generation surveillance (SGS) </li></ul><ul><li>______________________________________________ </li></ul><ul><li>A cross-sectional survey during 2007 in five major cities </li></ul><ul><li>Population: Female sex workers (FSWs), male sex workers (MSWs) and injecting drug users (IDUs) </li></ul><ul><li>Preceded by geographic mapping </li></ul><ul><li>Sample Size: Total of 6,000 behavioral questionnaires and 6,000 dried blood spot (DBS) samples </li></ul><ul><li>Sampling Procedure: Multistage cluster sampling for IDUs and FSWs & MSWs through respondent driven sampling (RDS) </li></ul><ul><li>All biological samples were screened by screening enzyme immunoassay (EIA) </li></ul><ul><li>Informed consent </li></ul><ul><li>Ethically approved protocol </li></ul>
  3. 3. Mapping Results <ul><li>12,923 Key Informant interviews in Five cities </li></ul><ul><li>Level-one (L-1) information </li></ul><ul><li>Information collected was validated during level two (L-2) </li></ul><ul><li>Triangulation </li></ul>Canada-Pakistan HIV/AIDS SURVEILLANCE PROJECT
  4. 4. Serological Results 2.5% among MSWs in one city. None of FSWs were found positive in Five cities. Canada-Pakistan HIV/AIDS SURVEILLANCE PROJECT
  5. 5. Behavioral Results Among IDUs 40% shared injection paraphernalia in five cities . Canada-Pakistan HIV/AIDS SURVEILLANCE PROJECT
  6. 6. Network Interaction 27.7% IDUs paid FSW for sex in past 6 months 18.6% FSWs had sex with IDUs in last 6 months 5.4% MSWs had sex with IDUs in last 6 months 17.1% IDUs paid MSW for sex in past 6 months IDU MSW FSW 4.9% 3.3 %
  7. 7. Conclusion <ul><li>Concentrated epidemic among IDUs </li></ul><ul><li>Sexual networks exists </li></ul><ul><li>Presence of un-protected sex </li></ul><ul><li>Interruption of transmission to non-injecting sexual partners </li></ul>Canada-Pakistan HIV/AIDS SURVEILLANCE PROJECT
  8. 8. ACKNOWLEDGMENTS High Risk Groups National & Punjab AIDS Control Program Consortium/Field team CIDA